196 PHYSIOLOGY CHAP. 



conditions the stomach was not evacuated in spite of the most 

 vigorous impulses of abdominal compression. 



On the other hand, we know that in coughing and in defaeca- 

 tion, when the abdominal muscles and diaphragm come energetically 

 into play, there is no vomiting, because the stomach remains 

 passive. Schiff (1867) further noted that in certain nervous 

 affections vomiting is inhibited, notwithstanding the most 

 powerful efforts of abdominal compression. He also adduced the 

 fact that in fistula- dogs it has been proved by introducing a 

 finger in the direction of the cardia that it dilates actively during 

 vomiting, owing to the contraction of the longitudinal fibres 

 which spread out from the oesophagus into the cardia. In fact, 

 when these fibres were divided in the dog he found that vomiting 

 no longer occurred. 



At the commencement of vomiting, Schwartz often observed 

 contraction of the longitudinal layer of gastric muscle fibres, 

 which commenced at the pylorus, and brought it nearer to the 

 fundus. The surgeon Patry (1863) made observations on vomiting 

 in a young man who was wounded after a heavy meal and had an 

 abdominal aperture and protrusion of the stomach. On replacing 

 it in the peritoneum vomiting ensued, during which strong but 

 slow contractions were seen from pylorus to cardia, until the 

 stomach had entirely emptied itself without assistance from the 

 diaphragm and abdominal muscles. 



In order to demonstrate the active participation of the 

 stomach in vomiting, Openchowski (1889) paralysed its move- 

 ments by ligation of the thoracic aorta above the diaphragm. 

 After inoculations of apomorphine or lobeline he saw energetic 

 spasms of sickness, without the least regurgitation of the gastric 

 contents. On removing the ligature from the aorta, regurgitation 

 occurred regularly. He described the modifications of the normal 

 peristalsis of the stomach under the action of emetics (copper 

 sulphate, apomorphine). There is at first disquiet of the intestines, 

 then spasm of the pylorus, followed by contractions of the antrum, 

 which are propagated as antiperistaltic waves to the lower and 

 middle third of the stomach, while the upper or cardiac part 

 widens at the same time, so that the viscus finally assumes the 

 form of a pear with its dilated part turned upwards the contents 

 of the stomach being forced out at the oesophagus. In most cases 

 the dilatation of the cardiac part precedes the antiperistaltic 

 motions of the remainder which (particularly at the pyloric 

 antrum) are the main factors in the act of vomiting. This cycle 

 of phenomena is repeated many times, periodically, in the form 

 of spasms. 



Liittig (1873) was the first to note at the beginning of vomiting 

 a strong inspiration and closure of the glottis, which must produce 

 considerable negative pressure inside the thorax, sufficient to 



